Systemic treatment of gastrooesophageal adenocarcinoma

Per Pfeiffer (1), Markus H. Moehler (2)
(1) Odense University Hospital & Institute of Clinical Research, University of Southern Denmark
(2) University Medical Center, Johannes GutenbergUniversity Mainz, I. Medizinische Klinik und Poliklinik

Few of chemotherapeutic drugs are effective and used for the treatment aGEA. Palliative chemotherapy prolongs overall survival and improves quality of life. The median OS in large randomized trials are approaching 12 months but in unselected populations the median OS only around 6 months. The median age for mEGA is around 70 years but the median age in most of the randomized trials is only around 60 years or even younger and therefore patients in trials are highly selected. A number of different fi rst-line regimens have been validated for use in this setting, but there is as yet no consensus recommendation on a world-wide combination. A combination of a platinum based (cisplatin or oxaliplatin) and a fl uoropyrimidine (5-FU, capecitabien or S-1) represents the cornerstone of fi rst line treatment. The addition of docetaxel to such doublets improve overall survival further, albeit at the cost of increased toxicity but a docetaxel triple regimen should be considered in fi t younger patients. Trastuzumab was the fi rst targeted drug to be approved in aGEA. Addition of trastuzumab to double chemotherapy is very tolerable and increase effi cacy. Second-line therapy is standard and recently it was shown that ramucirumab deliver clinical meaningful benefi t as monotherapy or in combination with paclitaxel. The preliminary show promising efficacy of immunotherapy and randomized study are recruiting patients with aGEA.


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